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Yue Y, Yang X, Zhang L, Xiao X, Nabar NR, Lin Y, Hao L, Zhang D, Huo J, Li J, Cai X, Wang M. Low-intensity pulsed ultrasound upregulates pro-myelination indicators of Schwann cells enhanced by co-culture with adipose-derived stem cells. Cell Prolif 2016; 49:720-728. [PMID: 27625295 PMCID: PMC6496622 DOI: 10.1111/cpr.12298] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/24/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Peripheral nerve injuries are a common occurrence, resulting in considerable patient suffering; it also represents a major economic burden on society. To improve treatment options following peripheral nerve injuries, scientists aim to find a way to promote Schwann cell (SC) myelination to help nerves to carry out their functions effectively. In this study, we investigated myelination ability of SCs, regulated by co-culture with adipose-derived stem cells (ASCs) or low-intensity pulsed ultrasound (LIPUS), and synergistic effects of combined treatments. MATERIALS AND METHODS Schwann cells were co-cultured with or without ASCs, and either left untreated or treated with LIPUS for 10 min/d for 1, 4 or 7 days. Effects of LIPUS and ASC co-culture on pro-myelination indicators of SCs were analysed by real-time PCR (RT-PCR), Western blotting and immunofluorescence staining (IF). RESULTS Our results indicate that ASC-SC co-culture and LIPUS, together or individually, promoted mRNA levels of epidermal growth factor receptor 3 (EGFR3/ErbB3), neuregulin1 (NRG1), early growth response protein 2 (Egr2/Krox20) and myelin basic protein (MBP), with corresponding increases in protein levels of ErbB3, NRG1 and Krox20. Interestingly, combination of ASC-SC co-culture and LIPUS displayed the most remarkable effects. CONCLUSION We demonstrated that ASCs upregulated pro-myelination indicators of SCs by indirect contact (through co-culture) and that effects could be potentiated by LIPUS. We conclude that LIPUS, as a mechanical stress, may have potential in nerve regeneration with potential clinical relevance.
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Affiliation(s)
- Yuan Yue
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Xingmei Yang
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China.
- Oral Implant Center, West China School of Stomatology, Sichuan University, Chengdu, China.
| | - Liang Zhang
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Oral Implant Center, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Xun Xiao
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Neel R Nabar
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Yunfeng Lin
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Liang Hao
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Dongjiao Zhang
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Jingyi Huo
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Jingle Li
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoxiao Cai
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Oral Implant Center, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Min Wang
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China.
- Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China.
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Li Z, Jin Z. Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis. Ther Clin Risk Manag 2016; 12:1635-1641. [PMID: 27877046 PMCID: PMC5108599 DOI: 10.2147/tcrm.s118748] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent years, studies have reported the appropriate use of verapamil for keloids and hypertrophic scars. METHODS Searches were conducted on the databases Medline, Embase, Cochrane, PubMed, and China National Knowledge Infrastructure from 2006 to July 2016. State12.0 was used for literature review, data extraction, and meta-analysis. Treatment groups were divided into verapamil and nonverapamil group. Nonverapamil group includes steroids and intense pulsed light (IPL) therapy. Total effective rates include cure rate and effective rate. Cure: skin lesions were completely flattened, became soft and symptoms disappeared. Efficacy: skin lesions subsided, patient significantly reduced symptoms. Inefficient definition of skin was progression free or became worse. Random-effects model was used for the meta-analysis. RESULTS Six studies that included 331 patients with keloids and hypertrophic scars were analyzed. Analysis of the total effective rate of skin healing was performed. The total effective rates in the two groups were 54.07% (verapamil) and 53.18% (nonverapamil), respectively. The meta-analysis showed that there was no difference between the two groups. We also compared the adverse reactions between the verapamil treatment group and the steroids treatment group in two studies, and the result indicated that the verapamil group showed less adverse reactions. CONCLUSION There were no differences between the application of verapamil and nonverapamil group in keloids and hypertrophic scars treatment. Verapamil could act as an effective alternative modality in the prevention and treatment of keloid and hypertrophic scars. A larger number of studies are required to confirm our conclusion.
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Affiliation(s)
- Zhouna Li
- Department of Dermatology, Yanbian University Affiliated hospital, Yanji, Jilin, People’s Republic of China
| | - Zhehu Jin
- Department of Dermatology, Yanbian University Affiliated hospital, Yanji, Jilin, People’s Republic of China
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Ogawa R, Akaishi S. Endothelial dysfunction may play a key role in keloid and hypertrophic scar pathogenesis – Keloids and hypertrophic scars may be vascular disorders. Med Hypotheses 2016; 96:51-60. [DOI: 10.1016/j.mehy.2016.09.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/26/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022]
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54
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Hannaman MR, Fitts DA, Doss RM, Weinstein DE, Bryant JL. The refined biomimetic NeuroDigm GEL™ model of neuropathic pain in a mature rat. F1000Res 2016. [PMID: 28620451 PMCID: PMC5461904 DOI: 10.12688/f1000research.9544.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Many humans suffering with chronic neuropathic pain have no objective evidence of an etiological lesion or disease. Frequently their persistent pain occurs after the healing of a soft tissue injury. Based on clinical observations over time, our hypothesis was that after an injury in mammals the process of tissue repair could cause chronic neural pain. Our objectives were to create the delayed onset of neuropathic pain in rats with minimal nerve trauma using a physiologic hydrogel, and characterize the rats' responses to known analgesics and a targeted biologic. Methods: In mature male Sprague Dawley rats (age 9.5 months) a percutaneous implant of tissue-derived hydrogel was placed in the musculofascial tunnel of the distal tibial nerve. Subcutaneous morphine (3 mg/kg), celecoxib (10 mg/kg), gabapentin (25 mg/kg) and duloxetine (10 mg/kg) were each screened in the model three times each over 5 months after pain behaviors developed. Sham and control groups were used in all screenings. A pilot study followed in which recombinant human erythropoietin (200 units) was injected by the GEL™ neural procedure site. Results: The GEL group gradually developed mechanical hypersensitivity lasting months. Morphine, initially effective, had less analgesia over time. Celecoxib produced no analgesia, while gabapentin and duloxetine at low doses demonstrated profound analgesia at all times tested. The injected erythropoietin markedly decreased bilateral pain behavior that had been present for over 4 months, p ≤ 0.001. Histology of the GEL group tibial nerve revealed a site of focal neural remodeling, with neural regeneration, as found in nerve biopsies of patients with neuropathic pain. Conclusion: The refined NeuroDigm GEL™ model induces a neural response resulting in robust neuropathic pain behavior. The analgesic responses in this model reflect known responses of humans with neuropathic pain. The targeted recombinant human erythropoietin at the ectopic neural lesion appears to alleviate the persistent pain behavior in the GEL™ model rodents.
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Affiliation(s)
- Mary R Hannaman
- NeuroDigm Corporation, Colorado Springs, CO, 80906, USA.,Department of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Douglas A Fitts
- Office of Animal Welfare, University of Washington, Seattle, WA, 98195, USA
| | - Rose M Doss
- Department of Biology, University of Colorado, Colorado Springs, CO, 80918, USA
| | | | - Joseph L Bryant
- Animal Model Division, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Hannaman MR, Fitts DA, Doss RM, Weinstein DE, Bryant JL. The refined biomimetic NeuroDigm GEL™ Model of neuropathic pain in the mature rat. F1000Res 2016; 5:2516. [DOI: 10.12688/f1000research.9544.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 01/10/2023] Open
Abstract
Background:Many humans suffering with chronic pain have no clinical evidence of a lesion or disease. They are managed with a morass of drugs and invasive procedures. Opiates usually become less effective over time. In many, their persistent pain occurs after the healing of a soft tissue injury. Current animal models of neuropathic pain typically create direct neural damage with open surgeries using ligatures, neurectomies, chemicals or other forms of deliberate trauma. However, we have observed clinically that after an injury in humans, the naturally occurring process of tissue repair can cause chronic neural pain.Methods:We demonstrate how the refined biomimetic NeuroDigm GEL™ Model, in the mature male rat, gradually induces neuropathic pain behavior with a nonsurgical percutaneous implant of tissue-derived hydrogel in the musculo-fascial tunnel of the distal tibial nerve. Morphine, Celecoxib, Gabapentin and Duloxetine were each screened in the model three times each over 5 months after pain behaviors developed. A pilot study followed in which recombinant human erythropoietin was applied to the GEL neural procedure site.Results:The GEL Model gradually developed neuropathic pain behavior lasting months. Morphine, initially effective, had less analgesia over time. Celecoxib produced no analgesia, while gabapentin and duloxetine at low doses had profound analgesia at all times tested. The injected erythropoietin markedly decreased bilateral pain behavior that had been present for over 4 months. Histology revealed a site of focal neural remodeling, with neural regeneration, as in human biopsies.Conclusion:The refined NeuroDigm GEL™ Model induces localized neural remodeling resulting in robust neuropathic pain behavior. The analgesics responses in this model reflect known responses of humans with neuropathic pain. The targeted recombinant human erythropoietin appears to heal the ectopic focal neural site, as demonstrated by the extinguishing of neuropathic pain behavior present for over 4 months.
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Meirte J, Moortgat P, Anthonissen M, Maertens K, Lafaire C, De Cuyper L, Hubens G, Van Daele U. Short-term effects of vacuum massage on epidermal and dermal thickness and density in burn scars: an experimental study. BURNS & TRAUMA 2016; 4:27. [PMID: 27574695 PMCID: PMC4964043 DOI: 10.1186/s41038-016-0052-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vacuum massage is a non-invasive mechanical massage technique invented to treat burns and scars. To date, no effects of vacuum massage on thickness and density of human scar tissue have been reported. The process in which external stimuli are converted into biochemical responses in the cell is known as mechanotransduction. In the skin endothelial cells, fibroblasts and myofibroblasts embedded in the extracellular matrix (ECM) sense mechanical stimuli (created by vacuum massage) and may promote intracellular processes leading to matrix remodelling. Since mechanotransduction could be a plausible working mechanism for vacuum massage as an anti-scarring therapy, this study aims to investigate the short-term effects of vacuum massage on thickness and density of epidermis and dermis in burn scars in order to find proof of ECM remodelling. METHODS A one group experimental study was performed. Patients with burn scars on upper extremities, lower extremities, and trunk were recruited for participation in this study. The DUB®cutis 22 MHz ultrasound scanner was used to assess thickness and density of the epidermal and dermal skin layers. After baseline measurements, vacuum massage was performed according to a pre-defined protocol. Measurements were carried out at 5 min, 30 min, 1 h, and 2 h post-intervention. RESULTS Thirteen scar sites from 9 different patients were investigated. In 8 out of the 13 scar sites, a disruption of the epidermis was noticed after the vacuum massage. Five minutes after the intervention, epidermal density decreased statistically significantly (p = .022) and dermal thickness increased (p = .018). Both changes lasted for more than 1 h, but after 2 h, the changes were no longer statistically significant. Dermal density decreased significantly (p = .048) immediately after the intervention, and this decrease was still present after 2 h (p = .011). CONCLUSIONS Preliminary results show that the disruption of the epidermis may indicate that vacuum massage could be able to actually breach the skin barrier. The statistically significant changes in the dermal layers could suggest an increased ECM production after vacuum massage.
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Affiliation(s)
- Jill Meirte
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Peter Moortgat
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
| | - Mieke Anthonissen
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
| | - Koen Maertens
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cynthia Lafaire
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- ZNA Stuivenberg, Burn Center, Antwerp, Belgium
| | - Lieve De Cuyper
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- ZNA Stuivenberg, Burn Center, Antwerp, Belgium
| | - Guy Hubens
- Department of Antwerp Surgical Training Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Ulrike Van Daele
- Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
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Kuang R, Wang Z, Xu Q, Cai X, Liu T. Exposure to Varying Strain Magnitudes Influences the Conversion of Normal Skin Fibroblasts Into Hypertrophic Scar Cells. Ann Plast Surg 2016; 76:388-93. [DOI: 10.1097/sap.0000000000000654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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58
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De Jesus AM, Aghvami M, Sander EA. A Combined In Vitro Imaging and Multi-Scale Modeling System for Studying the Role of Cell Matrix Interactions in Cutaneous Wound Healing. PLoS One 2016; 11:e0148254. [PMID: 26840835 PMCID: PMC4739727 DOI: 10.1371/journal.pone.0148254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/15/2016] [Indexed: 12/22/2022] Open
Abstract
Many cell types remodel the extracellular matrix of the tissues they inhabit in response to a wide range of environmental stimuli, including mechanical cues. Such is the case in dermal wound healing, where fibroblast migrate into and remodel the provisional fibrin matrix in a complex manner that depends in part on the local mechanical environment and the evolving multi-scale mechanical interactions of the system. In this study, we report on the development of an image-based multi-scale mechanical model that predicts the short-term (24 hours), structural reorganization of a fibrin gel by fibroblasts. These predictive models are based on an in vitro experimental system where clusters of fibroblasts (i.e., explants) were spatially arranged into a triangular geometry onto the surface of fibrin gels that were subjected to either Fixed or Free in-plane mechanical constraints. Experimentally, regional differences in short-term structural remodeling and cell migration were observed for the two gel boundary conditions. A pilot experiment indicated that these small differences in the short-term remodeling of the fibrin gel translate into substantial differences in long-term (4 weeks) remodeling, particularly in terms of collagen production. The multi-scale models were able to predict some regional differences in remodeling and qualitatively similar reorganization patterns for the two boundary conditions. However, other aspects of the model, such as the magnitudes and rates of deformation of gel, did not match the experiments. These discrepancies between model and experiment provide fertile ground for challenging model assumptions and devising new experiments to enhance our understanding of how this multi-scale system functions. These efforts will ultimately improve the predictions of the remodeling process, particularly as it relates to dermal wound healing and the reduction of patient scarring. Such models could be used to recommend patient-specific mechanical-based treatment dependent on parameters such as wound geometry, location, age, and health.
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Affiliation(s)
- Aribet M. De Jesus
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States of America
| | - Maziar Aghvami
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States of America
| | - Edward A. Sander
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States of America
- * E-mail:
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Abstract
BACKGROUND Linear closure (LC) is the most common reconstructive design for cutaneous defects. Successful performance of a LC is dependent on both appropriate surgical planning and technical execution. OBJECTIVE To review the design and execution of LCs on the face. MATERIALS AND METHODS A systematic evaluation of LCs is provided to guide a logical approach for the repair of cutaneous facial defects. RESULTS Reproducibly excellent aesthetic and functional results may be achieved with strategies that reduce incisional tension, preserve free margin position, and restore skin contour. Cosmetic unit borders and relaxed skin tension lines may be used to further camouflage facial scars. A comprehensive knowledge of facial anatomy, biomechanical properties of the skin, and incisional tension vectors facilitates correct preoperative planning and intraoperative technique. CONCLUSION Proper design and execution of LCs allow for enhanced cosmesis and permit the cutaneous surgeon to progress to more technically advanced surgical procedures such as cutaneous flaps.
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Hypertrophic scar contracture is mediated by the TRPC3 mechanical force transducer via NFkB activation. Sci Rep 2015; 5:11620. [PMID: 26108359 PMCID: PMC4479825 DOI: 10.1038/srep11620] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/01/2015] [Indexed: 12/22/2022] Open
Abstract
Wound healing process is a complex and highly orchestrated process that ultimately results in the formation of scar tissue. Hypertrophic scar contracture is considered to be a pathologic and exaggerated wound healing response that is known to be triggered by repetitive mechanical forces. We now show that Transient Receptor Potential (TRP) C3 regulates the expression of fibronectin, a key regulatory molecule involved in the wound healing process, in response to mechanical strain via the NFkB pathway. TRPC3 is highly expressed in human hypertrophic scar tissue and mechanical stimuli are known to upregulate TRPC3 expression in human skin fibroblasts in vitro. TRPC3 overexpressing fibroblasts subjected to repetitive stretching forces showed robust expression levels of fibronectin. Furthermore, mechanical stretching of TRPC3 overexpressing fibroblasts induced the activation of nuclear factor-kappa B (NFκB), a regulator fibronectin expression, which was able to be attenuated by pharmacologic blockade of either TRPC3 or NFκB. Finally, transplantation of TRPC3 overexpressing fibroblasts into mice promoted wound contraction and increased fibronectin levels in vivo. These observations demonstrate that mechanical stretching drives fibronectin expression via the TRPC3-NFkB axis, leading to intractable wound contracture. This model explains how mechanical strain on cutaneous wounds might contribute to pathologic scarring.
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Brouwer KM, Lundvig DMS, Middelkoop E, Wagener FADTG, Von den Hoff JW. Mechanical cues in orofacial tissue engineering and regenerative medicine. Wound Repair Regen 2015; 23:302-11. [PMID: 25787133 DOI: 10.1111/wrr.12283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/11/2015] [Indexed: 01/26/2023]
Abstract
Cleft lip and palate patients suffer from functional, aesthetical, and psychosocial problems due to suboptimal regeneration of skin, mucosa, and skeletal muscle after restorative cleft surgery. The field of tissue engineering and regenerative medicine (TE/RM) aims to restore the normal physiology of tissues and organs in conditions such as birth defects or after injury. A crucial factor in cell differentiation, tissue formation, and tissue function is mechanical strain. Regardless of this, mechanical cues are not yet widely used in TE/RM. The effects of mechanical stimulation on cells are not straight-forward in vitro as cellular responses may differ with cell type and loading regime, complicating the translation to a therapeutic protocol. We here give an overview of the different types of mechanical strain that act on cells and tissues and discuss the effects on muscle, and skin and mucosa. We conclude that presently, sufficient knowledge is lacking to reproducibly implement external mechanical loading in TE/RM approaches. Mechanical cues can be applied in TE/RM by fine-tuning the stiffness and architecture of the constructs to guide the differentiation of the seeded cells or the invading surrounding cells. This may already improve the treatment of orofacial clefts and other disorders affecting soft tissues.
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Affiliation(s)
- Katrien M Brouwer
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands
| | - Ditte M S Lundvig
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Beverwijk, The Netherlands
| | - Frank A D T G Wagener
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Johannes W Von den Hoff
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
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Comparison of Combination Therapy (Steroid, Calcium Channel Blocker, and Interferon) With Steroid Monotherapy for Treating Human Hypertrophic Scars in an Animal Model. Ann Plast Surg 2015; 74 Suppl 2:S162-7. [DOI: 10.1097/sap.0000000000000470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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63
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Monument MJ, Hart DA, Salo PT, Befus AD, Hildebrand KA. Neuroinflammatory Mechanisms of Connective Tissue Fibrosis: Targeting Neurogenic and Mast Cell Contributions. Adv Wound Care (New Rochelle) 2015; 4:137-151. [PMID: 25785237 DOI: 10.1089/wound.2013.0509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/26/2013] [Indexed: 12/26/2022] Open
Abstract
Significance: The pathogenesis of fibrogenic wound and connective tissue healing is complex and incompletely understood. Common observations across a vast array of human and animal models of fibroproliferative conditions suggest neuroinflammatory mechanisms are important upstream fibrogenic events. Recent Advances: As detailed in this review, mast cell hyperplasia is a common observation in fibrotic tissue. Recent investigations in human and preclinical models of hypertrophic wound healing and post-traumatic joint fibrosis provides evidence that fibrogenesis is governed by a maladaptive neuropeptide-mast cell-myofibroblast signaling pathway. Critical Issues: The blockade and manipulation of these factors is providing promising evidence that if timed correctly, the fibrogenic process can be appropriately regulated. Clinically, abnormal fibrogenic healing responses are not ubiquitous to all patients and the identification of those at-risk remains an area of priority. Future Directions: Ultimately, an integrated appreciation of the common pathobiology shared by many fibrogenic connective tissue conditions may provide a scientific framework to facilitate the development of novel antifibrotic prevention and treatment strategies.
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Affiliation(s)
- Michael J. Monument
- Division of Orthopaedic Surgery, McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A. Hart
- Division of Orthopaedic Surgery, McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul T. Salo
- Division of Orthopaedic Surgery, McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A. Dean Befus
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin A. Hildebrand
- Division of Orthopaedic Surgery, McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Surgical technique for optimal outcomes. J Am Acad Dermatol 2015; 72:377-87. [DOI: 10.1016/j.jaad.2014.06.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 11/23/2022]
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Hochman B, Isoldi FC, Furtado F, Ferreira LM. New approach to the understanding of keloid: psychoneuroimmune-endocrine aspects. Clin Cosmet Investig Dermatol 2015; 8:67-73. [PMID: 25709489 PMCID: PMC4329995 DOI: 10.2147/ccid.s49195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The skin is a dynamic and complex organ that relies on the interrelation among different cell types, macromolecules, and signaling pathways. Further, the skin has interactions with its own appendages and other organs such as the sebaceous glands and hair follicles, the kidney, and adrenal glands; systems such as the central nervous system; and axes such as the hypothalamic–pituitary–adrenal axis. These continuous connections give the skin its versatility, and when an injury is caused, some triggers start a cascade of events designed to restore its integrity. Nowadays, it is known that this psychoneuroimmune–endocrine intercommunication modulates both the homeostatic condition and the healing process. In this sense, the skin conditions before a trauma, whether of endogenous (acne) or exogenous origin (injury or surgical incision), could regulate the process of tissue repair. Most skin diseases such as psoriasis and atopic dermatitis, among others, have in their pathophysiology a psychogenic component that triggers integrated actions in the nervous, immune, and endocrine systems. However, fibroproliferative disorders of wound healing, such as hypertrophic scar and keloid, are not yet included in this listing, despite showing correlation with stress, especially with the psychosocial character. This review, by understanding the “brain–skin connection”, presents evidence that allows us to understand the keloid as a psychomediated disease.
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Affiliation(s)
- Bernardo Hochman
- Plastic Surgery Division, Federal University of São Paulo, São Paulo, Brazil
| | | | - Fabianne Furtado
- Plastic Surgery Division, Federal University of São Paulo, São Paulo, Brazil
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Challenges in the Modeling of Wound Healing Mechanisms in Soft Biological Tissues. Ann Biomed Eng 2014; 43:1654-65. [DOI: 10.1007/s10439-014-1200-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/19/2014] [Indexed: 02/03/2023]
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Zhang L, Yang X, Yue Y, Ye J, Yao Y, Fu Y, Li G, Yao Q, Lin Y, Gong P. Cyclic mechanical stress modulates neurotrophic and myelinating gene expression of Schwann cells. Cell Prolif 2014; 48:59-66. [PMID: 25418681 DOI: 10.1111/cpr.12151] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/12/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the response of Schwann cells to cyclic compressive and tensile stresses of different durations of stimulation. MATERIALS AND METHODS RSC96 cells were subjected to cyclic tensile stress or compressive stress; for either, cells in five groups were treated for 0, 1, 2, 24 and 48 h respectively. Enzyme-linked immunosorbent assay was conducted to detect secretion of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 and neurotrophin-4 in the culture medium. Real-time PCR was conducted to quantify mRNA expression of neurotrophins including NGF, BDNF, neurotrophin-3 and neurotrophin-4, and myelin-related genes including Sox10, Krox20, neuregulin 1, NCAM, N-cadherin, P0, MAG and MBP. Immunofluorescent staining was performed to visualize Krox20 and F-actin in the tensile groups. RESULTS Within 24 h, cells treated with cyclic tensile stress expressed and secreted significantly more BDNF, while cyclic compression down-regulated BDNF expression. Cells treated with both tensile and compressive stress down-regulated expression of NRG1, NCAM, Krox20 and Sox10 at all time points. Expression of N-cadherin was not affected by either stretch or compression. F-actin was down-regulated by tensile stress. CONCLUSIONS Both tensile and compressive loading down-regulated expression of several important myelin-related Schwann cells genes and thus facilitated demyelination. Tensile stress meanwhile promoted secretion of BDNF by Schwann cells within 24 h, which may contribute to maintenance and repair of damaged axons. These effects of mechanical stress might have been mediated by the actin cytoskeleton.
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Affiliation(s)
- L Zhang
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
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Suarez E, Syed F, Alonso-Rasgado T, Bayat A. Identification of biomarkers involved in differential profiling of hypertrophic and keloid scars versus normal skin. Arch Dermatol Res 2014; 307:115-33. [PMID: 25322916 DOI: 10.1007/s00403-014-1512-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
Among raised dermal scar types, keloid (KS) and hypertrophic scars (HS) are considered to present clinical similarities, but there are no known specific biomarkers that allow both scar types to be easily distinguished. Development and progression of raised dermal scars comprises the activation of several molecular pathways and cell defence mechanisms leading to elevated extracellular matrix component synthesis, delayed apoptosis, altered migration and differentiation. Therefore, the aim here was to identify biomarkers that may differentiate between KS and HS compared to normal skin (NS). To achieve this aim, NS (n = 14), KS (n = 14) and HS (n = 14) biopsies were evaluated using histology by H&E staining. Tissue biopsies and primary fibroblasts (passages 0-4) were employed to assess the gene expression levels of 21 biomarkers selected from our previous microarray studies using qRT-PCR. Finally, protein expression was evaluated using In-Cell Western Blotting in primary fibroblasts (p 0-4). Our results demonstrated that out of the 21 biomarkers screened at mRNA and protein levels, α2β1-integrin, Hsp27, PAI-2, MMP-19 and CGRP showed significantly higher expression (p < 0.05) in KS compared to NS and HS. Additionally, these five key biomarkers were found to be significantly higher (p < 0.05) at mRNA level in KS taken from the sternum, a region known to be subjected to high mechanical forces in the body during the performance of daily movements. In conclusion, our findings offer potential molecular targets in raised dermal scars differentiation. Future targeted research may allow provision of diagnostic and prognostic markers in keloid versus hypertrophic scars.
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Affiliation(s)
- Edna Suarez
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology (MIB), University of Manchester, 131 Princess Road, Manchester, M1 7ND, UK
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Lancerotto L, Orgill DP. Mechanoregulation of Angiogenesis in Wound Healing. Adv Wound Care (New Rochelle) 2014; 3:626-634. [PMID: 25302137 DOI: 10.1089/wound.2013.0491] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/06/2013] [Indexed: 12/15/2022] Open
Abstract
Significance: Mechanical forces are important regulators of cell and tissue function. Endothelial cells proliferate in response to tissue stretch and the mechanical properties of the environment direct capillary sprouting and growth. As the vascular network is a key factor in physiology and disease, control of the vascularity by means of mechanical forces could lead to the development of innovative therapeutic strategies. Recent Advances: Increased understanding of mechanobiology has stimulated translational research and allowed the development and optimization of clinical devices that exploit mechanical forces for the treatment of diseases, in particular in the field of wound healing. Stretching in distraction osteogenesis and tissue expansion induces neogenesis of well-vascularized tissues. In micro-deformational wound therapy, micro-mechanical distortions of the wound bed stimulate cell proliferation and angiogenesis by stretching resident cells to improve healing of difficult wounds. Relief from tension antagonizes proliferation and angiogenesis in primarily closed wounds allowing for better scar quality. Critical Issues: The integration of mechanobiology into traditional cell biology and pathophysiology in general is not yet complete and further research is needed to fill existing gaps, in particular in the complexity of in vivo conditions. Future Directions: Still largely unexplored approaches based on mechanical perturbation of the micro-/macro-environment can be devised to overcome the limits of current strategies in a broad spectrum of clinical conditions.
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Affiliation(s)
- Luca Lancerotto
- Clinic of Plastic Surgery, University of Padova , Italy . ; Division of Plastic Surgery, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
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70
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Xiao H, Wang D, Huo R, Wang Y, Feng Y, Li Q. Mechanical tension promotes skin nerve regeneration by upregulating nerve growth factor expression. Neural Regen Res 2014; 8:1576-81. [PMID: 25206453 PMCID: PMC4145962 DOI: 10.3969/j.issn.1673-5374.2013.17.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/06/2013] [Indexed: 11/18/2022] Open
Abstract
This study aimed to explore the role of mechanical tension in hypertrophic scars and the change in nerve density using hematoxylin-eosin staining and S100 immunohistochemistry, and to observe the expression of nerve growth factor by western blot analysis. The results demonstrated that mechanical tension contributed to the formation of a hyperplastic scar in the back skin of rats, in conjunction with increases in both nerve density and nerve growth factor expression in the scar tissue. These experimental findings indicate that the cutaneous nervous system plays a role in hypertrophic scar formation caused by mechanical tension.
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Affiliation(s)
- Hu Xiao
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Dechang Wang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Ran Huo
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Yibing Wang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Yongqiang Feng
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Qiang Li
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
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71
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Takada H, Furuya K, Sokabe M. Mechanosensitive ATP release from hemichannels and Ca²⁺ influx through TRPC6 accelerate wound closure in keratinocytes. J Cell Sci 2014; 127:4159-71. [PMID: 25097230 DOI: 10.1242/jcs.147314] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cutaneous wound healing is accelerated by exogenous mechanical forces and is impaired in TRPC6-knockout mice. Therefore, we designed experiments to determine how mechanical force and TRPC6 channels contribute to wound healing using HaCaT keratinocytes. HaCaT cells were pretreated with hyperforin, a major component of a traditional herbal medicine for wound healing and also a TRPC6 activator, and cultured in an elastic chamber. At 3 h after scratching the confluent cell layer, the ATP release and intracellular Ca(2+) increases in response to stretching (20%) were live-imaged. ATP release was observed only in cells at the frontier facing the scar. The diffusion of released ATP caused intercellular Ca(2+) waves that propagated towards the rear cells in a P2Y-receptor-dependent manner. The Ca(2+) response and wound healing were inhibited by ATP diphosphohydrolase apyrase, the P2Y antagonist suramin, the hemichannel blocker CBX and the TRPC6 inhibitor diC8-PIP2. Finally, the hemichannel-permeable dye calcein was taken up only by ATP-releasing cells. These results suggest that stretch-accelerated wound closure is due to the ATP release through mechanosensitive hemichannels from the foremost cells and the subsequent Ca(2+) waves mediated by P2Y and TRPC6 activation.
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Affiliation(s)
- Hiroya Takada
- Department of Physiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Nagoya, 466-8550, Japan
| | - Kishio Furuya
- Department of Physiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Nagoya, 466-8550, Japan Mechanobiology Laboratory, Nagoya University Graduate School of Medicine, 65 Tsurumai, Nagoya, 466-8550, Japan
| | - Masahiro Sokabe
- Department of Physiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Nagoya, 466-8550, Japan Mechanobiology Laboratory, Nagoya University Graduate School of Medicine, 65 Tsurumai, Nagoya, 466-8550, Japan
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72
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Ryu HW, Cho JH, Lee KS, Cho JW. Prevention of Thyroidectomy Scars in Korean Patients Using a New Combination of Intralesional Injection of Low-Dose Steroid and Pulsed Dye Laser Starting within 4 Weeks of Suture Removal. Dermatol Surg 2014; 40:562-8. [DOI: 10.1111/dsu.12472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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73
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Januszyk M, Wong VW, Bhatt KA, Vial IN, Paterno J, Longaker MT, Gurtner GC. Mechanical offloading of incisional wounds is associated with transcriptional downregulation of inflammatory pathways in a large animal model. Organogenesis 2014; 10:186-93. [PMID: 24739276 DOI: 10.4161/org.28818] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cutaneous scarring is a major source of morbidity and current therapies to mitigate scar formation remain ineffective. Although wound fibrosis and inflammation are highly linked, only recently have mechanical forces been implicated in these pathways. Our group has developed a topical polymer device that significantly reduces post-injury scar formation via the manipulation of mechanical forces. Here we extend these studies to examine the genomewide transcriptional effects of mechanomodulation during scar formation using a validated large animal model, the red Duroc pig. We demonstrate that mechanical loading of incisional wounds upregulates expression of genes associated with inflammatory and fibrotic pathways, and that device-mediated offloading of these wounds reverses these effects. Validation studies are needed to clarify the clinical significance of these findings.
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Affiliation(s)
- Michael Januszyk
- Department of Surgery; Division of Plastic and Reconstructive Surgery; Stanford University School of Medicine; Stanford, CA USA
| | - Victor W Wong
- Department of Surgery; Division of Plastic and Reconstructive Surgery; Stanford University School of Medicine; Stanford, CA USA
| | - Kirit A Bhatt
- Department of Surgery; Division of Plastic and Reconstructive Surgery; Stanford University School of Medicine; Stanford, CA USA
| | - Ivan N Vial
- Department of Surgery; Division of Plastic and Reconstructive Surgery; Stanford University School of Medicine; Stanford, CA USA
| | - Josemaria Paterno
- Department of Surgery; Division of Plastic and Reconstructive Surgery; Stanford University School of Medicine; Stanford, CA USA
| | - Michael T Longaker
- Department of Surgery; Division of Plastic and Reconstructive Surgery; Stanford University School of Medicine; Stanford, CA USA
| | - Geoffrey C Gurtner
- Department of Surgery; Division of Plastic and Reconstructive Surgery; Stanford University School of Medicine; Stanford, CA USA
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74
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Kerwin LY, El Tal AK, Stiff MA, Fakhouri TM. Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches. Int J Dermatol 2014; 53:922-36. [DOI: 10.1111/ijd.12436] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Abdel Kader El Tal
- Department of Dermatology; Wayne State University; Dearborn MI USA
- Department of Dermatology; American University of Beirut; New York NY USA
| | - Mark A. Stiff
- Department of Dermatology; Wayne State School of Medicine; Southfield MI USA
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75
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Valero C, Javierre E, García-Aznar JM, Gómez-Benito MJ. A cell-regulatory mechanism involving feedback between contraction and tissue formation guides wound healing progression. PLoS One 2014; 9:e92774. [PMID: 24681636 PMCID: PMC3969377 DOI: 10.1371/journal.pone.0092774] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/25/2014] [Indexed: 01/22/2023] Open
Abstract
Wound healing is a process driven by cells. The ability of cells to sense mechanical stimuli from the extracellular matrix that surrounds them is used to regulate the forces that cells exert on the tissue. Stresses exerted by cells play a central role in wound contraction and have been broadly modelled. Traditionally, these stresses are assumed to be dependent on variables such as the extracellular matrix and cell or collagen densities. However, we postulate that cells are able to regulate the healing process through a mechanosensing mechanism regulated by the contraction that they exert. We propose that cells adjust the contraction level to determine the tissue functions regulating all main activities, such as proliferation, differentiation and matrix production. Hence, a closed-regulatory feedback loop is proposed between contraction and tissue formation. The model consists of a system of partial differential equations that simulates the evolution of fibroblasts, myofibroblasts, collagen and a generic growth factor, as well as the deformation of the extracellular matrix. This model is able to predict the wound healing outcome without requiring the addition of phenomenological laws to describe the time-dependent contraction evolution. We have reproduced two in vivo experiments to evaluate the predictive capacity of the model, and we conclude that there is feedback between the level of cell contraction and the tissue regenerated in the wound.
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Affiliation(s)
- Clara Valero
- Multiscale in Mechanical and Biological Engineering (M2BE), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
- * E-mail:
| | - Etelvina Javierre
- Centro Universitario de la Defensa de Zaragoza, Academia General Militar, Zaragoza, Spain
| | - José Manuel García-Aznar
- Multiscale in Mechanical and Biological Engineering (M2BE), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - María José Gómez-Benito
- Multiscale in Mechanical and Biological Engineering (M2BE), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
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Abstract
Every element or cell in the human body produces substances that communicate and respond in an autocrine or paracrine mode, consequently affecting organs and structures that are seemingly far from each other. The same also applies to the skin. In fact, when the integrity of the skin has been altered, or when its healing process is disturbed, it becomes a source of symptoms that are not merely cutaneous. The skin is an organ, and similar to any other structure, it has different functions in addition to connections with the central and peripheral nervous system. This article examines pathological responses produced by scars, analyzing definitions and differences. At the same time, it considers the subcutaneous fascias, as this connective structure is altered when there is a discontinuous cutaneous surface. The consequence is an ample symptomatology, which is not limited to the body area where the scar is located, such as a postural or trigeminal disorder.
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Affiliation(s)
- Bruno Bordoni
- Rehabilitation Cardiology Institute of Hospitalization and Care with Scientific Address, S Maria Nascente Don Carlo Gnocchi Foundation. CRESO Osteopathic Centre for Research and Studies
| | - Emiliano Zanier
- EdiAcademy, Milano, Italy. CRESO Osteopathic Centre for Research and Studies
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77
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Theoret CL, Olutoye OO, Parnell LKS, Hicks J. Equine exuberant granulation tissue and human keloids: a comparative histopathologic study. Vet Surg 2013; 42:783-9. [PMID: 24015864 DOI: 10.1111/j.1532-950x.2013.12055.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 07/21/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare histopathologic features of a fibroproliferative disorder in horses (exuberant granulation tissue-EGT) and people (keloid). SAMPLE POPULATION Archival tissue samples of EGT (n = 8) and keloid (12). METHODS After automated hematoxylin and eosin, histochemical (Gomori trichrome, Verhoeff-van Gieson elastin) and immunohistochemical (vimentin, α-smooth muscle actin, CD34, CD68, CD117) stainings, tissue sections were evaluated using a semi-quantitative grading scale for presence or absence of ulceration, keloidal collagen, myofibroblasts, and elastic fibers as well as degree of inflammation, fibrosis, vascularity, and orientation of collagen fibers. RESULTS Superficial dermis and deep dermis of both horses and people had increased numbers of haphazardly oriented thickened collagen fibers; however, only keloids contained "keloidal" collagen. Fibroblast numbers were markedly increased in both groups but only EGT had myofibroblasts. Minimal vascularity was observed in the deep dermis of both groups. The superficial dermis in EGT was characterized by small vessels within immature granulation tissue. Macrophages and mast cells were infrequently found in both groups but polymorphonuclear cells were markedly increased in EGT. CONCLUSIONS Humans and horses are the only mammals known to naturally develop excessive granulation during wound healing; however, similarities and differences between fibroblast populations and associated collagen have not been reported. Inflammatory response may contribute to observed differences in the cellular populations, with EGT possessing markedly increased myofibroblasts, small vessels, and acute inflammatory cells compared with keloids. Further work is warranted to develop common treatment strategies for these fibroproliferative conditions.
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78
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Holt BM, Betz DH, Ford TA, Beck JP, Bloebaum RD, Jeyapalina S. Pig dorsum model for examining impaired wound healing at the skin-implant interface of percutaneous devices. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:2181-2193. [PMID: 23832453 PMCID: PMC3770289 DOI: 10.1007/s10856-013-4975-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/10/2013] [Indexed: 05/27/2023]
Abstract
Percutaneous medical devices are indispensable in contemporary clinical practice, but the associated incidence of low to moderate mortality infections represents a significant economic and personal cost to patients and healthcare providers. Percutaneous osseointegrated prosthetics also suffer from a similar risk of infection, limiting their clinical acceptance and usage in patients with limb loss. We hypothesized that transepidermal water loss (TEWL) management at the skin-implant interface may improve and maintain a stable skin-to-implant interface. In this study, skin reactions in a 3-month, pig dorsum model were assessed using standard histology, immunohistochemistry, and quantitative image analysis. Immunohistochemical analysis of peri-implant tissue explants showed evidence of: continuous healing (cytokeratin 6+), hypergranulation tissue (procollagen+), hyper-vascularity (collagen 4+), and the presence of fibrocytes (CD45+ and procollagen type 1+). Importantly, the gross skin response was correlated to a previous load-bearing percutaneous osseointegrated prosthetic sheep study conducted in our lab. The skin responses of the two models indicated a potentially shared mechanism of wound healing behavior at the skin-implant interface. Although TEWL management did not reduce skin migration at the skin-implant interface, the correlation of qualitative and quantitative measures validated the pig dorsum model as a high-throughput platform for translational science based percutaneous interface investigations in the future.
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Affiliation(s)
- Brian Mueller Holt
- Bone and Joint Research Laboratory, DVA SLC HCS, 500 Foothill Drive (151F), Salt Lake City, UT 84148
- Department of Orthopaedics, University of Utah Health Care, Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108
| | - Daniel Holod Betz
- Bone and Joint Research Laboratory, DVA SLC HCS, 500 Foothill Drive (151F), Salt Lake City, UT 84148
| | - Taylor Ann Ford
- Bone and Joint Research Laboratory, DVA SLC HCS, 500 Foothill Drive (151F), Salt Lake City, UT 84148
| | - James Peter Beck
- Bone and Joint Research Laboratory, DVA SLC HCS, 500 Foothill Drive (151F), Salt Lake City, UT 84148
- Department of Orthopaedics, University of Utah Health Care, Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108
| | - Roy Drake Bloebaum
- Bone and Joint Research Laboratory, DVA SLC HCS, 500 Foothill Drive (151F), Salt Lake City, UT 84148
- Department of Orthopaedics, University of Utah Health Care, Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108
| | - Sujee Jeyapalina
- Bone and Joint Research Laboratory, DVA SLC HCS, 500 Foothill Drive (151F), Salt Lake City, UT 84148
- Department of Orthopaedics, University of Utah Health Care, Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108
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Maleki S, Björck HM, Paloschi V, Kjellqvist S, Folkersen L, Jackson V, Franco-Cereceda A, Eriksson P. Aneurysm Development in Patients With Bicuspid Aortic Valve (BAV): Possible Connection to Repair Deficiency? AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2013; 1:13-22. [PMID: 26798668 DOI: 10.12945/j.aorta.2013.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/15/2013] [Indexed: 01/25/2023]
Affiliation(s)
- Shohreh Maleki
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna M Björck
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Valentina Paloschi
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sanela Kjellqvist
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lasse Folkersen
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Jackson
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per Eriksson
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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80
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Ogawa R, Hsu CK. Mechanobiological dysregulation of the epidermis and dermis in skin disorders and in degeneration. J Cell Mol Med 2013; 17:817-22. [PMID: 23672502 PMCID: PMC3822886 DOI: 10.1111/jcmm.12060] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 03/01/2013] [Indexed: 11/27/2022] Open
Abstract
During growth and development, the skin expands to cover the growing skeleton and soft tissues by constantly responding to the intrinsic forces of underlying skeletal growth as well as to the extrinsic mechanical forces from body movements and external supports. Mechanical forces can be perceived by two types of skin receptors: (1) cellular mechanoreceptors/mechanosensors, such as the cytoskeleton, cell adhesion molecules and mechanosensitive (MS) ion channels, and (2) sensory nerve fibres that produce the somatic sensation of mechanical force. Skin disorders in which there is an abnormality of collagen [e.g. Ehlers–Danlos syndrome (EDS)] or elastic (e.g. cutis laxa) fibres or a malfunction of cutaneous nerve fibres (e.g. neurofibroma, leprosy and diabetes mellitus) are also characterized to some extent by deficiencies in mechanobiological processes. Recent studies have shown that mechanotransduction is crucial for skin development, especially hemidesmosome maturation, which implies that the pathogenesis of skin disorders such as bullous pemphigoid is related to skin mechanobiology. Similarly, autoimmune diseases, including scleroderma and mixed connective tissue disease, and pathological scarring in the form of keloids and hypertrophic scars would seem to be clearly associated with the mechanobiological dysfunction of the skin. Finally, skin ageing can also be considered as a degenerative process associated with mechanobiological dysfunction. Clinically, a therapeutic strategy involving mechanoreceptors or MS nociceptor inhibition or acceleration together with a reduction or augmentation in the relevant mechanical forces is likely to be successful. The development of novel approaches such as these will allow the treatment of a broad range of cutaneous diseases.
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Affiliation(s)
- Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan.
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81
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The role of wound healing and its everyday application in plastic surgery: a practical perspective and systematic review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1. [PMID: 25289204 PMCID: PMC4174176 DOI: 10.1097/gox.0b013e31828ff9f4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND After surgery it is often recommended that patients should refrain from strenuous physical activity for 4-6 weeks. This recommendation is based on the time course of wound healing. Here, we present an overview of incisional wound healing with a focus on 2 principles that guide our postoperative recommendations: the gain of tensile strength of a wound over time and the effect of mechanical stress on wound healing. METHODS A systematic search of the English literature was conducted using OVID, Cochrane databases, and PubMed. Inclusion criteria consisted of articles discussing the dynamics of incisional wound healing, and exclusion criteria consisted of articles discussing nonincisional wounds. RESULTS Experiments as early as 1929 laid the groundwork for our postoperative activity recommendations. Research using animal models has shown that the gain in tensile strength of a surgical wound is sigmoidal in trajectory, reaching maximal strength approximately 6 weeks postoperatively. Although human and clinical data are limited, the principles gained from laboratory investigation have provided important insights into the relationship among mechanical stress, collagen dynamics, and the time course of wound healing. CONCLUSION Our postoperative activity recommendations are based on a series of animal studies. Clinical research supporting these recommendations is minimal, with the most relevant clinical data stemming from early motion protocols in the orthopedic literature. We must seek to establish clinical data to support our postoperative activity recommendations so that we can maximize the physiologic relationships between wound healing and mechanical stress.
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Wong VW, Beasley B, Zepeda J, Dauskardt RH, Yock PG, Longaker MT, Gurtner GC. A Mechanomodulatory Device to Minimize Incisional Scar Formation. Adv Wound Care (New Rochelle) 2013; 2:185-194. [PMID: 24527342 DOI: 10.1089/wound.2012.0396] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To mechanically control the wound environment and prevent cutaneous scar formation. APPROACH We subjected various material substrates to biomechanical testing to investigate their ability to modulate skin behavior. Combinations of elastomeric materials, adhesives, and strain applicators were evaluated to develop topical stress-shielding devices. Noninvasive imaging modalities were utilized to characterize anatomic site-specific differences in skin biomechanical properties in humans. The devices were tested in a validated large animal model of hypertrophic scarring. Phase I within-patient controlled clinical trials were conducted to confirm their safety and efficacy in scar reduction in patients undergoing abdominoplasty surgery. RESULTS Among the tested materials and device applicators, a polymer device was developed that effectively off-loaded high tension wounds and blocked pro-fibrotic pathways and excess scar formation in red Duroc swine. In humans, different anatomic sites exhibit unique biomechanical properties that may correlate with the propensity to form scars. In the clinical trial, utilization of this device significantly reduced incisional scar formation and improved scar appearance for up to 12 months compared with control incisions that underwent routine postoperative care. INNOVATION This is the first device that is able to precisely control the mechanical environment of incisional wounds and has been demonstrated in multiple clinical trials to significantly reduce scar formation after surgery. CONCLUSION Mechanomodulatory strategies to control the incisional wound environment can significantly reduce pathologic scarring and fibrosis after surgery.
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Affiliation(s)
- Victor W. Wong
- Department of Surgery, Stanford University, Stanford, California
| | - Bill Beasley
- Neodyne Biosciences, Inc., Menlo Park, California
| | - John Zepeda
- Neodyne Biosciences, Inc., Menlo Park, California
| | - Reinhold H. Dauskardt
- Department of Materials Science and Engineering, Stanford University, Stanford, California
| | - Paul G. Yock
- Department of Biomedical Engineering, Stanford University, Stanford, California
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Grinnell F, Ho CH. The effect of growth factor environment on fibroblast morphological response to substrate stiffness. Biomaterials 2013; 34:965-74. [PMID: 23140998 PMCID: PMC3511597 DOI: 10.1016/j.biomaterials.2012.10.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 10/11/2012] [Indexed: 01/02/2023]
Abstract
According to conventional understanding regarding dependence of cell behavior on substrate stiffness, tissue cells typically remain round on soft substrates but spread on stiff substrates. The current studies were carried out to learn if the growth factor environment influenced the foregoing relationship. Using standard methods, we prepared planar (2D) polyacrylamide (PA) gels ranging from 0.5 to 40 kPa and covalently cross-linked with fibronectin and collagen at concentrations ranging from 2.5 to 50 μg/ml. We carried out experiments with fibroblasts varying in their ability to form actin stress fibers and focal adhesions. In fetal bovine serum (FBS) containing medium--the growth factor environment in which most studies on cell spreading and substrate stiffness have been carried out--cell spreading increased with increasing substrate stiffness and adhesion ligand density. However, in platelet-derived growth factor (PDGF) containing medium, cell spreading was relatively independent of substrate stiffness and adhesion ligand density except little cell attachment occurred in the complete absence of cross-linked adhesion ligands. If cell contraction was blocked with blebbistatin, then cell spreading in FBS-containing medium became independent of substrate stiffness. The findings suggest that under growth factor conditions that stimulate global cell contraction (FBS), cell spreading cannot occur unless adhesion ligand density and substrate stiffness result in cell-substrate interactions strong enough to resist and overcome the inward tractional force. Under growth factor conditions that stimulate global cell protrusion (PDGF), such resistance is not required.
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Affiliation(s)
- Frederick Grinnell
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9039, USA.
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84
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Huang C, Akaishi S, Hyakusoku H, Ogawa R. Are keloid and hypertrophic scar different forms of the same disorder? A fibroproliferative skin disorder hypothesis based on keloid findings. Int Wound J 2012; 11:517-22. [PMID: 23173565 DOI: 10.1111/j.1742-481x.2012.01118.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 10/02/2012] [Accepted: 10/11/2012] [Indexed: 01/08/2023] Open
Abstract
Hypertrophic scars (HSs) and keloids are commonly seen as two different diseases by both clinicians and pathologists. However, as supported by histological evidence showing they share increased numbers of fibroblasts and accumulate collagen products, HS and keloid might be different forms of the same pathological entity, rather than separate conditions. To test this hypothesis, keloids from patients who underwent scar excisions (n = 20) in Nippon Medical School from 2005 to 2010 were examined histologically. The proportion and distribution of cellular and matrix collagen components were evaluated at the centre and periphery of each sample. In keloid samples, coexistence of hyalinised collagen, which is the most important pathognomonic characteristic of a keloid and dermal nodules that are considered to be characteristic of HS, was found. Moreover, hyalinised fibres appeared to initiate from the corner of the dermal nodules. Key features of inflammation such as microvessels, fibroblasts and inflammatory cells all decreased gradually from the periphery to the centre of keloids, indicative of reduced inflammation in the centre. Thus, we hypothesise that HS and keloid can be considered as successive stages of the same fibroproliferative skin disorder, with differing degrees of inflammation that might be affected by genetic predisposition.
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Affiliation(s)
- Chenyu Huang
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic Surgery, Meitan General Hospital, Beijing, China
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85
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da Rocha-Azevedo B, Ho CH, Grinnell F. Fibroblast cluster formation on 3D collagen matrices requires cell contraction dependent fibronectin matrix organization. Exp Cell Res 2012; 319:546-55. [PMID: 23117111 DOI: 10.1016/j.yexcr.2012.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 12/21/2022]
Abstract
Fibroblasts incubated on 3D collagen matrices in serum or lysophosphatidic acid (LPA)-containing medium self-organize into clusters through a mechanism that requires cell contraction. However, in platelet-derived growth factor (PDGF)-containing medium, cells migrate as individuals and do not form clusters even though they constantly encounter each other. Here, we present evidence that a required function of cell contraction in clustering is formation of fibronectin (FN) fibrillar matrix. We found that in serum or LPA but not in PDGF or basal medium, cells organized FN (both serum and cellular) into a fibrillar, detergent-insoluble matrix. Cell clusters developed concomitant with FN matrix formation. FN fibrils accumulated beneath cells and along the borders of cell clusters in regions of cell-matrix tension. Blocking Rho kinase or myosin II activity prevented FN matrix assembly and cell clustering. Using siRNA silencing and function-blocking antibodies and peptides, we found that cell clustering and FN matrix assembly required α5β1 integrins and fibronectin. Cells were still able to exert contractile force and compact the collagen matrix under the latter conditions, which showed that contraction was not sufficient for cell clustering to occur. Our findings provide new insights into how procontractile (serum/LPA) and promigratory (PDGF) growth factor environments can differentially regulate FN matrix assembly by fibroblasts interacting with collagen matrices and thereby influence mesenchymal cell morphogenetic behavior under physiologic circumstances such as wound repair, morphogenesis and malignancy.
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Affiliation(s)
- Bruno da Rocha-Azevedo
- Department of Cell Biology, UT Southwestern Medical Center 5323, Harry Hines Boulevard, Dallas, TX 75390-9039, USA
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86
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Wong VW, Longaker MT, Gurtner GC. Soft tissue mechanotransduction in wound healing and fibrosis. Semin Cell Dev Biol 2012; 23:981-6. [PMID: 23036529 DOI: 10.1016/j.semcdb.2012.09.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/25/2012] [Indexed: 12/17/2022]
Abstract
Recent evidence suggests that mechanical forces can significantly impact the biologic response to injury. Integrated mechanical and chemical signaling networks have been discovered that enable physical cues to regulate disease processes such as pathologic scar formation. Distinct molecular mechanisms control how tensional forces influence wound healing and fibrosis. Conceptual frameworks to understand cutaneous repair have expanded beyond traditional cell-cytokine models to include dynamic interactions driven by mechanical force and the extracellular matrix. Strategies to manipulate these biomechanical signaling networks have tremendous therapeutic potential to reduce scar formation and promote skin regeneration.
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Affiliation(s)
- Victor W Wong
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
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87
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Tubbs KJ, Silva RC, Ramirez HE, Castleman WL, Collins WO. A comparison of two methods of endoscopic dilation of acute subglottic stenosis using a ferret model. Laryngoscope 2012; 123:253-8. [DOI: 10.1002/lary.23508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2012] [Indexed: 11/08/2022]
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Ogawa R, Okai K, Tokumura F, Mori K, Ohmori Y, Huang C, Hyakusoku H, Akaishi S. The relationship between skin stretching/contraction and pathologic scarring: The important role of mechanical forces in keloid generation. Wound Repair Regen 2012; 20:149-57. [DOI: 10.1111/j.1524-475x.2012.00766.x] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 12/26/2011] [Indexed: 12/16/2022]
Affiliation(s)
- Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery; Nippon Medical School; Tokyo; Japan
| | - Kazuhisa Okai
- Research and Development Department; Nichiban Co., Ltd; Tokyo; Japan
| | - Fumio Tokumura
- Medicinal Safety Information Group; Nichiban Co., Ltd; Hidaka; Japan
| | - Kazuyuki Mori
- Research and Development Department; Nichiban Co., Ltd; Tokyo; Japan
| | - Yasutaka Ohmori
- Department of Plastic, Reconstructive and Aesthetic Surgery; Nippon Medical School; Tokyo; Japan
| | - Chenyu Huang
- Department of Plastic, Reconstructive and Aesthetic Surgery; Nippon Medical School; Tokyo; Japan
| | - Hiko Hyakusoku
- Department of Plastic, Reconstructive and Aesthetic Surgery; Nippon Medical School; Tokyo; Japan
| | - Satoshi Akaishi
- Department of Plastic, Reconstructive and Aesthetic Surgery; Nippon Medical School; Tokyo; Japan
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